Hospital Billing Never Ends

Saturday

Unpredictable hospital billing can lead to financial anxiety about the prospect of dealing with insurance companies even before a surgery has happened.

LYING on the gurney in the emergency room last May, facing an appendectomy, I should have been focused on my well-being.

Instead, all I could think was: What is this going to cost?

It was not that I was uninsured. But I had pre-operation financial anxiety about the prospect of dealing with my insurance company in regard to surgery that had not even happened yet.

My husband and I had a plan with a $3,000 deductible, and I took comfort knowing that the money was safe in our savings account. I also knew that emergency care and surgery were covered at 80 percent.

What that other 20 percent might amount to was my primary worry — plus what all the á la carte items might cost. That was the hard lesson I had learned the year before, after giving birth, then struggling to decode the bills for various prenatal tests. The doctor might be covered for a test — but my lab work was not. Or if the lab work was covered, the “facility fee“ was extra.

It is the insurance shell game: You think you know what to expect and you are totally wrong. Surprise!

As it turned out, the appendectomy was a success, but there was plenty of fretting once the actual bills arrived. The first one landed about two weeks after the operation and they did not stop for months. Each statement a revision of the last, except when they were duplicates. Each commanded in large block letters: Payment is due upon receipt of this invoice.

Hoping to deal practically with this morass, my husband and I called the toll-free number listed on the statements. That is when we learned that we were now dealing with an external billing company, not the hospital. The customer service representative said we actually did not have to pay anything yet — because at that point, none of the charges had been submitted to our insurance company.

Annoyed, we now adopted a passive-aggressive strategy: If they would not give us a straightforward accounting, we would not bother to send in a check.

This was partly on the advice of a friend, who said we should wait until the bills reflected all the insurance adjustments, even if that took a couple of months.

That seemed smart — until a collections agency notified us that we had a $1,200 bill. We decided to take a more conciliatory attitude.

My husband and I reluctantly agreed to set up a payment plan to keep the billing company happy — even though we were not 100 percent sure what we were paying for. At least we knew that these initial payments were going toward the deductible.

I was particularly chagrined because taking a firm stand had worked something akin to magic the year before, when this same insurer refused to cover the bill for the birth of our son, which took place, as planned, at home. Not only was my midwife in the network, she had a package deal with this particular provider: Her $4,000 fee, which included prenatal visits as well as the delivery, was fully covered.

When the insurance company informed us that it would pay for less than half of that — for no clear reason — I wrote a letter expressing outrage, pointing out that in a hospital, the birth would have cost the company far more. Miraculously, the insurance gods reversed their decision.

But high dudgeon was not working now. Despite agitated discussions with the billing company to find out what we owed (“We don’t know, we just send you the bills”), and the hospital (“Everything is being processed by your insurance company”) and our insurer (“We are still waiting for the final bills from the hospital”), it took seven months before we got a final bill.

Even then, we were ready to dispute hidden charges. But — another surprise — everything seemed to add up. It was almost disappointing. We owed $2,879.15 — $500 of which would finish paying our deductible. “That’s all I’m showing that you owe, as of today,“ said a woman in the hospital accounting department.

As of today. Does it ever really end?

I have serious doubts. Just as this appendectomy matter was being resolved we got another statement, a ghost from procedures past. The hospital where I had my sonograms two years ago when I was pregnant sent a bill for more than $600. I am not sure why. I have to call them.

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